The Health Care Blog – Page 992 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Internet expert fields questions on participatory medicine

Jun 26, 2008• 1

By Susannah Fox

I always suspect that audience members have as much to share as I have to say. So when Mary Madden and I received an invitation to speak at the National Institutes of Health we created a participatory talk about participatory medicine: 35 minutes of our findings; 45 minutes of discussion.

It was a blisteringly hot day, so we ended up having 50 people in the room and about 50 more watching the videocast from the cool of their offices on the NIH campus. The video is a little blurry, so I recommend treating it like a podcast and downloading the slides separately, but you might enjoy hearing how we wove together our research on digital footprints, Web 2.0, and health.

Here is a sample of the excellent questions we were asked and our attempts to answer them:

Check the WSJ opinion section for more BS on Medicare Advantage

Jun 26, 2008• 2

By Matthew Holt

Scott Gottlieb, who passes for what the right call a health economist these days, has an opinion piece in the WSJ singing the praises of Medicare Advantage plans.

Anyone reading the article would think that Medicare Advantage plans provide better and cheaper care than the FFS program, showing the triumph of private enterprise over government welfare. And that’s why evil Democrats hate them so much.

Unbelievably, Gottlieb ignores the extra payments Medicare Advantage have received over the standard Medicare program since 2004. Even Karen Ignagni doesn’t do that any more. The AHIP crew has long changed its argument from “we do it better and cheaper” to “we help poor black and Hispanic seniors get better benefits, and the fact that we rake a ton off the top and the taxpayer gets screwed is just the cost of doing business, sorry!” But Gottleib is back in the dark ages. Is this really the best the right can do?

Online bullying care management works

Jun 25, 2008• 2

By Matthew Holt

So says a study out in JAMA today from Group Health of Puget Sound. They randomly divided high blood pressure patients into three groups. Being Group Health members they all had online access to the MyGroupHealth site and services, but the second group got blood pressure cuffs and training on the site. That made no difference. But the third group got all that and online counseling from pharmacists about every two weeks.

After 12 months, about one-third of the patients in the first two groups achieved normal blood pressure. However, with the Internet-based pharmacist care, more than half the patients got their blood pressure down to normal.

Which is both good and bad news. Good news because it’s somewhat scalable to have online counseling from clinicians, in that it’s more convenient for patients and clinicians. Bad news because it’s much, much more scalable to have computers do all the work. But currently computers alone, even when the patients are given more training and services don’t do much better than general medical treatment.

Much of what needs to be done to make care management effective is to figure out how to replace and augment the most precious resource (skilled humans) with a cheaper one (less skilled humans, possibly a long way away, and computers). But at least this combination has been shown to be effective.

Can Connected Health survive the political economy of health care?

Jun 25, 2008

By Matthew Holt

Jennifer Priester & Joe Kvedar over at Partners’ Center for Connected Health asked me to step in and be the guest host of their discussion group for the month. I wrote a piece called, Can Connected Health survive the political economy of health care?

Please go take and look and of course feel free to join in the discussion there.

Congress votes for higher Medicare costs when voting down competition

Jun 25, 2008• 7

By Sarah Arnquist

Congress is bowing to pressure (read: financial contributions) from medical equipment makers that stand to lose money if Medicare expands its competitive bidding program.

The NY Times reports today that the House approved legislation Tuesday that would delay the launch of the competitive bidding program for 18 months — all to appease a few companies that are scared of staying viable in, gasp, a competitive market.

The results of the pilot bidding program show this is good policy that will save Medicare and individuals money. The Times reports:

"When Medicare awarded competitively bid contracts to some 325
companies to serve the 10 metropolitan areas, it reduced equipment
prices by 26 percent on what it would have paid for the same equipment
under the current fee schedule. That means that if the contracts were
allowed to proceed, beneficiaries would save 26 percent on their
co-payments. Medicare would save $125 million the first year and as
much as $1 billion a year if the program went nationwide."

Yet, good policy may lose this battle.

As NY Times columnist David Leonhardt and an accompanying editorial aptly point out, this small battle is ominously prophetic of the impending battles over health care reform.

"By standing in the way of this competition, Congress is really standing up for higher health care costs," Leonhardt wrote.

It will be interesting to see which Congressmen and women vote against competitive bidding now and then assail the rising costs of health care from the podium this fall.

For the cynical out there, this is a reminder of what you already know.

As industry veteran Brian Klepper told me yesterday, "Only innocents and little children think health care reform is going to happen through policy. It’s not going to happen because half of all the money is unnecessary and because Congress is on the take."

Lots of Health 2.0 articles indicates that it’s heating up

Jun 25, 2008• 2

By Matthew Holt

I don’t know if it’s just me, but there appears to be a quick vogue in round-ups of the Health 2.0 world at the moment.

UCLA doc John Luo wrote about******@**ng.com&utm_campaign=06.17.08+l+MDNG+Anesthesiology/PM+eDigest:+Futuristic+Medicine;+Cultural+Competency&utm_source=Listrak&utm_medium=Email&utm_term=/articles/PC_Taking_the_Wheel?utm_source=Listrak&utm_medium=Email&utm_term=%2Farticles%2FPC%5FTaking%5Fthe%5FWheel&utm_content=sjohnson%40mdng%2Ecom&utm_campaign=06%2E17%2E08+l+MDNG+Anesthesiology%2FPM+eDigest%3A+Futuristic+Medicine&utm_content=je******************@***oo.com&utm_campaign=06.24.08+l+MDNG+Pediatrics+eDigest:+Premature+Births+Up;+Pregnancy+and+Child+Obesity”> The People and Companies Driving Health 2.0 on MNDG. He gives a good overview, and mentions some familiar and not too familiar names

In the slightly more rarefied atmosphere of the American Academy of Neurology, Barbara Scherokman of Kaiser Permanente, and Michael Segal, from SimulConsult, give a great overview of the components in Health 2.0 for Neurologists. They focus alot of course on BrainTalk and PatientsLikeMe.

Talking of PatientsLikeMe, I missed this due to being in the Jordanian desert at the time, but in March Wired’s Tom Goetz (who was on a panel in the March 2007 Health 2.0 conference) wrote a fantastic and long article about PatientsLikeMe called Practicing Patients for the New York Times in March. I learned alot and I’ve been giving PLM demos in public for the last year (and no, I’m not a shareholder!)

The people at at nursing online education database bombard me with their posts, but this one about Taking Control of Your Health Records throws in everything including the kitchen sink, but has some interesting links.

At ReadWriteWeb, Richard MacManus has been looking at DiabetesMine and DiabeticConnect. Not surprising as he’s a geek who recently discovered that he had diabetes.

Meanwhile Indu Subaiya and I have been diving into the latest rash of companies wanting to present at Health 2.0. Just 12 months ago we were scratching around to come up with enough candidates to fill four demo panels. Now we have 20 panels and we don’t have enough room to show half of the people who want to present.

It won’t stay like this for ever of course, but it’s interesting to be in the middle of the maelstrom!

Expanding consumer ratings to home caregivers

Jun 25, 2008• 4

By Chiara Bell

It seems that everyone is chasing after doctor and hospital ratings. From Revolution Health to Yelp, consumers are encouraged to rate hospitals and physicians in their communities. Hospitals and physicians are the two obvious providers to rate in our health care system. However, I think we have left out, the largest and, arguably the most important members of the health care profession — nurses, certified caregivers and home health aides.

Let’s compare the numbers.

Today, there are approximately 4,927 community hospitals and an average of 800,000 licensed physicians in the United States. Comparatively, there are 1.4 million registered nurses, 749,000 licensed practical nurses, and 1.8 million certified nursing assistants, home health aides and non-certified caregivers.

That is roughly 4.1 Million members of the health care community that we have left out of the ratings game.

How preventing infections rose to the forefront of the patient safety movement

Jun 24, 2008• 1

By Bob Wachter Robert_wachter

The Joint Commission just released its 2009 National Patient Safety Goals, and –- no surprise –- they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is one of the most surprising twists of the patient safety revolution.

The inclusion – make that dominance – of infection prevention in the safety field was anything but preordained. The IOM Report on medical errors, which sparked the modern patient safety movement, mentions the word “infections” 8 times and the word “medications” 234 times. In other words, the Founding Fathers of patient safety didn’t appear to have preventing infections in mind when they articulated the scope of the endeavor.

So how did it come to pass that infection prevention became one of, if not the, central focus of the patient safety enterprise? The first step was recognition of the importance of measurement. Without measurable rates of adverse events, there could be no public reporting, no research demonstrating improvements, no pay for performance (or, more au currant, “no pay for errors” – note that more than half of the “no pay” entities on CMS’s present and proposed list are infections), and ultimately no one who could be held accountable for progress in safety.

Consumers seek health information to solve marketplace problems

Jun 24, 2008

By Jane Sarasohn-Kahn

Consumers, employers, payers and providers agree that information flows are critical to helping stem health care costs. While there is shared concern about health care costs, there is also a shared desire for more, accessible information and better online tools for managing it.

TriZetto’s report, Research Shows Healthcare Market Constituents Seek Information as Key to Solving the Affordability Crisis, surveys the landscape of stakeholders in American health care and lays out a rational approach to what the IT services firm calls integrated health care management.

TriZetto lays out five key themes that drive the imperative toward integrated health care management:

Health care affordability
Aligning incentives to change activities
Information access as king
The importance of leveraging information technology
Payers as change agents.

Health care is not recession-proof

Jun 23, 2008• 10

By Jeff Goldsmith

It is often accepted as conventional wisdom that health care is recession proof.

People get sick regardless of economic cycles, and the publicly funded safety net programs insure that people who need care get it. Yet if you look around the health system, what you see looks suspiciously like a recession: low single digit pharmaceutical cost growth, a collapse in high tech imaging and cardiovascular sales and clinical volumes, declining hospital admissions and rising bad debts. Is it possible that health care isn’t recession proof after all?